Facing up to health care

Keeping up with routine health care needs isn’t a problem when cruising. It’s rare to be in a place where quality care cannot be found, or reached quickly should an emergency arise. In Puerto Rico we played catch up with dentist and dermatology checkups.

We arrived in Puerto Rico expecting to hop-skip-jump across the south coast, continuing (we hoped) to blast our way east to the BVIs, then make southbound tracks to Grenada. In the landfall of Puerto Real, Marina Pescadería’s owner/manager, Jose Mendez, welcomed us like old friends. He had already arranged service from an outboard mechanic we asked after via email, and walked us through extensive recommendations to make the most of a short stay: beaches, restaurants, shops, services. Goodbyes with the Akira crew (their kids with our girls, above) was the only down side of our stop. Everything was easy with Jose’s help, and any concern we had about muddling through a few tasks with our lapsed Spanish evaporated.

But even just a few days is enough to work in a dental checkup, and the whole crew was overdue; Jose booked us an appointment with a recommended dentist in nearby Mayaguez. Dental care has been particularly easy to meet while cruising: Mayaguez, Puerto Rico, is the latest on our Dentist Around the World tour (Mexico…Australia…Malaysia…Seychelles…St. Martin…Puerto Rico).

All five Totem crew had teeth cleaned by a hygienist and checked by the dentist; two earned bonus sealant treatment, and xrays confirmed Niall’s wisdom teeth have to go…that comes later. Excellent care, nice facility, US board certified dentist…total bill, $300. A bargain, yet at the higher end of what we’ve paid along the way for routine dental care (the exception was Australia, which had prices similar to the US mainland).

Eastbound along Puerto Rico’s south coast, Totem’s engine overheated: the first sign that plans for a speedy trip to the Virgin Islands would be thwarted. Diverting to the port of Ponce, we called Jose for a recommendation. No problem! Despite the fact it was late afternoon on Friday, a couple of hours later Jose’s preferred diesel mechanic, Cesar, was sitting in Totem’s cockpit at 5:30pm sharing his ideas for troubleshooting.

Anticipating a week to deal with what we presumed to be a failing heat exchanger meant enough time to tick another health care item off the list – Jamie and I were due to see a derm, something we try to do annually. A few days later what we hoped to be a routine pass through a highly recommended clinic in Ponce…wasn’t so routine after all.

Jamie’s had a couple of troublesome spots on his face (treated by derms in Malaysia and South Africa); Drs. Villa and Sanchez didn’t like them a bit. My galaxy of freckles and moles turned up a few more suspect spots. Five biopsies, dozens of stitches, and a skin graft later: we are fine, but Jamie had both basal cell and squamous carcinomas on his face (my dysplastic nevi were just that: misbehaving cells, nipped before becoming problematic).

Dr Santaliz sutures Jamie while Dr Villa looks on

Most were done in Dr Villa’s clinic, but he felt the carcinoma on Jamie’s nose was best handled by Mohs surgery. With a phone call to his friend in San Juan, we were fit in for 10:00 the following morning—the doctor’s last day in the office before a family vacation (to go sailing in the BVIs, as it happened!).

All told, we had four office appointments; these appointments ran as long as Jamie’s three-hour adventure in the Mohs clinic, which required three passes (and an olive-sized divot) at tissue on his nose before the cell margins were pronounced clean. And then, there was a “house call” when Dr Villa came see us in Salinas (we moved to this sweet little anchorage, more cruiser-friendly and affordable than Ponce) and removed his stitches en plein air…and bring us mangoes from the tree in his garden. When was the last time you heard of a doctor doing house calls?

Healing well, one week after the skin graft

All told, the dermatology adventure took a few weeks and cost a freckle under $4,000. It’s a chunk but we can deal (hey, anybody need a quote for a new sail from Jamie?). If you’d like to know more, this post details how we approach medical costs and insurance (cliff notes: catastrophic coverage to avoid financial devastation from a major event, and all routine care paid out of pocket).

The sun exposure we get from cruising clearly doesn’t help our situation here, but everyday exposure now isn’t the primary problem. The reality is that Jamie and I are experiencing this not so much because of cruising, but because of a combination of genetic factors and childhood sun exposure. OUR kids benefit from sunscreen; we spent our childhood summers outside before SPF was an acronym anyone knew. A dermatologist checking me, years ago, said we should give up on plans to take off on a sailboat. Well, no. But we can be careful and thoughtful about protecting ourselves from the sun. I’ve written about sun protection while cruising, and the advice is unchanged.

If there is a single takeaway from our health care adventures in Puerto Rico, it’s this: that quality care is available away from the comfortable range of home. If I can press a second point, it’s that care is generally quite affordable. It may not always be cheap, but along our travels–and a working annual budget that puts us below the poverty line in the USA–it is manageable, and strengthened a sidelong view on the insanity of insurance rates and medical costs in the US.

Meanwhile, our quick pass through Puerto Rico easily became a month. That’s fine. Sure, it’s added some stress as the hurricane season heats up, and a progressively growing series of “waves” off Africa trying to spin up into Caribbean hurricanes. That, too, has slowed progress as we take the prudent steps to remain near hurricane holes instead of pressing forward regardless. But taking care of health was the priority, and along the way it enabled myriad experiences by spending more time in Puerto Rico…

…like enjoying beautiful vistas from the mountains to the sea while driving to the dermatologist outside San Juan.

A rental car to get to doctor’s appointments provided easier day tripping to explore the history in Old San Juan…

…to find out of the way cafés, and indulge in a survey of pressed sandwiches (the best: at El Balcon del Coliseo in Ponce…WOW); recommendations from the doctors for the best roast pork, and a detour through the central ridge to find the perfect place to enjoy it.

Meanwhile, here we are about a month later, and you have to look up close to know Jamie’s had a hunk taken out of his nose.

Want to learn more about health care or other hot topics for cruising? In October, I’ll be at the US Sailboat Show in Annapolis—talking formally and informally to anyone with interest and time about their cruising questions! One of my six seminars at Cruisers U is specifically about health care, and will dive into much more detail than this post can cover.

October 5-8: staffing the booth at L&L Pardey Books, signing copies of Voyaging With Kids and telling anyone who will listen how inspiring Lin’s books are.

October 6: Cruising World Workshop: Prepare to Cast Off (register here)

October 9-10: Cruising Women seminar (part of Cruisers U): two full days, including a morning spent aboard a boat.